Early Cognitive Impairment in Middle-Aged Patients with Atrial Fibrillation:a Neuropsychological Study with Echocardiographic Correlates

Objectives: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and has increasingly been associated with cognitive impairment and dementia. Structural remodelling of the left atrium may contribute to early cognitive decline in patients with AF.This study aimed to evaluateearly cognitive impairment in middle-aged patients withAFusing comprehensive neuropsychological testing and to explore its association with conventional echocardiographic parameters of left atrial structure and function. Methods: Between 2023-2024, fifty-six consecutive outpatients with AF aged 45–65 years underwent clinical evaluation, transthoracic echocardiography, and comprehensive neuropsychological assessment using the Montreal Cognitive Assessment (MoCA) and the Consortium to Establish a Registry for Alzheimer’s Disease battery (CERAD). A con-trol group of 58 age group-matched individuals without known cardiovascular disease was included in comparative cognitiveanalyses.Results: Patients with AF demonstrat-edearly cognitive deficits, particularly in episodic memory and visuospatial functions, detectable even in individuals with normal MoCA scores. Patients with abnormal MoCA results exhibited more pronounced and widespread cognitive impairment. No statistically robust associations were observed between cognitive performance and conventional echocardiographic parameters of left atrial structure and function. These findings may reflect limited statistical power or the need for more sensitive markers of atrial remodeling. Conclusions: Early cognitive impairment in AF may be present before abnormalities are detectableby brief cognitive screening tools. The combined use of comprehensive neuropsychological assessment and echocardiographic evaluation may enhance early identification of cognitive vulnerability in this population. Further prospective studies are warranted to clarify the clinical relevance of atrial structural remodeling in this context.